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CVS Caremark study investigates medication adherence

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WOONSOCKET, R.I. — As Congress pieces together its proposals for health care reform, CVS Caremark Corp. is sponsoring research to examine patient adherence to prescription drugs and spotlight ways to boost adherence.

The drug store chain and pharmacy benefits manager said Wednesday that, working with researchers from Harvard and Brigham and Women’s Hospital, it expects the findings to give health professionals better insight into patient behavior and result in programs that health care providers and pharmacies can use to bolster medication adherence — ultimately helping to improve patient care and health outcomes by avoiding costly hospital treatment.

Nonadherence to essential chronic medications has been widely recognized as a major public health problem, CVS Caremark said, pointing to previous research cited in many medical journals. One quarter of original prescriptions for essential medications are never filled, and patients with chronic diseases such as diabetes and coronary artery disease adhere to their medication only about half of the time. Also, nonadherence is seen as a cause of preventable hospitalizations and patient illness, with costs to the U.S. health care system estimated at more than $200 billion annually.

"As the nation looks for ways to reduce health care spending, we need to improve patient compliance with prescribed drug therapies," Troy Brennan, executive vice president and chief medical officer at CVS Caremark, said in a statement. "Many reasons have been discussed for patient nonadherence, including cost, forgetfulness, confusion when taking multiple medications, and problems with renewing a prescription. This research, which will be available not only to CVS affiliates but also to all pharmacies, will help doctors, pharmacies, hospitals and health plans design programs to help patients stay on their prescribed medication treatments."

Brennan noted that noncompliance with a prescribed drug reduces or eliminates the positive effects of a medication, and patients who fail to take prescriptions properly can face unnecessary and expensive treatments, such as hospital admissions, readmissions and surgeries.

Patients are deemed noncompliant if they do not fill a new prescription or do not refill an existing one, take appropriate medication incorrectly (such as on the wrong schedule) or take the wrong medication dose.

Through a research agreement, CVS Caremark said it is working with faculty from Brigham and Women’s Hospital, Harvard Medical School and the Harvard Faculty of Arts and Sciences to develop an interdisciplinary initiative to improve medication use. The interdisciplinary approach will enable experts in areas such as psychology, sociology and political studies to bring their expertise about patient behavior and health care policy to bear on a complex public health problem, according to the company.

The research collaboration has four key components: determining the causes and scope of abandoned prescriptions; driving adherence through simplification and consolidation; evaluating the clinical and financial value of adherence incentives; and determining how electronic prescribing impacts costs, compliance and safety.

"This research will help us understand the reasons why patients do not take their medications as prescribed. We will use this information to develop effective, evidence-based approaches to improve prescription adherence," commented William Shrank, M.D., MSHS of Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School, and principal investigator of the program.


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